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. 2018 Dec 5;18(1):46.
doi: 10.1186/s40644-018-0182-4.

Tumor heterogeneity in gastrointestinal stromal tumors of the small bowel: volumetric CT texture analysis as a potential biomarker for risk stratification

Cui Feng  1 , Fangfang Lu  2 , Yaqi Shen  1 , Anqin Li  1 , Hao Yu  1 , Hao Tang  1 , Zhen Li  3 , Daoyu Hu  1
Affiliations

Tumor heterogeneity in gastrointestinal stromal tumors of the small bowel: volumetric CT texture analysis as a potential biomarker for risk stratification

Cui Feng et al. Cancer Imaging. .

Abstract

Background: To explore whether volumetric CT texture analysis (CTTA) can serve as a potential imaging biomarker for risk stratification of small bowel gastrointestinal stromal tumors (small bowel-GISTs).

Methods: A total of 90 patients with small bowel-GISTs were retrospectively reviewed, of these, 26 were rated as high risk, 13 as intermediate risk, and 51 as low or very low risk. Histogram parameters extracted from CT images were compared among small bowel-GISTs with different risk levels by using one-way analysis of variance. Receiver operating characteristics (ROCs) and areas under the curve (AUCs) were analyzed to determine optimal histogram parameters for stratifying tumor risk.

Results: Significant differences in mean attenuation, 10th, 25th, 50th, 75th and 90th percentile attenuation, and entropy were found among high, intermediate, and low risk small bowel-GISTs (p ≤ 0.001). Mean attenuation, 10th, 25th, 50th, 75th and 90th percentile attenuation, and entropy derived from arterial phase and venous phase images correlated significantly with risk levels (r = 0.403-0.594, r = 0.386-0.593, respectively). Entropy in venous phase reached the highest accuracy (AUC = 0.830, p < 0.001) for differentiating low risk from intermediate to high risk small bowel-GISTs, with a cut-off value of 5.98, and the corresponding sensitivity and specificity were 82.4 and 74.4%, respectively.

Conclusions: Volumetric CT texture features, especially entropy, may potentially serve as biomarkers for risk stratification of small bowel-GISTs.

Keywords: Computed tomography; Gastrointestinal stromal tumors; Pathology; Risk assessment; Texture analysis.

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Conflict of interest statement

Ethics approval and consent to participate

This retrospective study was approved by our institutional review board, and patient informed consent was waived.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of the study population
Fig. 2
Fig. 2
ROC curves for mean attenuation, median attenuation, 10th, 25th, 50th, 75th, and 90th percentile attenuation and entropy in differentiating low risk small bowel-GISTs from intermediate to high risk small bowel-GISTs in arterial phase (a) and venous phase (b)
Fig. 3
Fig. 3
CT texture analysis of small bowel-GISTs with different risk levels. CT images of high risk in arterial phase (a) and venous phase (b) show an irregular external growth mass situated in the right upper abdomen with heterogeneous enhancement in a 66-year-old female. Histograms in arterial phase (c) and venous phase (d) show lower distribution of CT values. Mean attenuation and entropy were 47.00HU and 5.23 in arterial phase, 57.64HU and 5.39 in venous phase, respectively. CT images of intermediate risk in the arterial phase (e) and venous phase (f) show a rounded external mass at the proximal jejunum in a 60-year-old male. Histograms in arterial phase (g) and venous phase (h) show the distribution of CT values. Mean attenuation and entropy were 68.72HU and 5.31 in arterial phase, 70.22HU and 5.66 in venous phase, respectively. CT images of low risk in the arterial phase (i) and venous phase (j) show an irregular internal mass with obvious enhancement located at the descending duodenum in a 60-year-old female. Histograms in arterial phase (k) and venous phase (l) show higher distribution of CT values. Mean attenuation and entropy were 155.15HU and 6.21 in arterial phase, 133.26HU and 6.14 in venous phase, respectively
See this image and copyright information in PMC

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